P912: COVID19 SEVERITY AND THERAPEUTIC OPTIONS IN PATIENTS WITH MULTIPLE MYELOMA
Authors: E. Karimova, E. Zhelnova, E. Baryakh, K. Yatskov, E. Zotina, E. Grishina, E. Paramonova, D. Gagloeva, E. Misyurina
Journal: HemaSphere (2022)

Background: Patients with multiple myeloma have higher risk of SARS-CoV-2 infection and higher risk of death than patients without MM Aims: Analysis of features of the course of COVID-19 in patients with MM. Methods: 89 pts with MM and COVID-19 were treated in the hospital from March 2020 to October 2021, 53 (60%) female, 36 (40%) male. The median age was 64 years (35-88 years). 32 pts (36%) were presented with active myeloma, 19 (21%) – R/R myeloma, 21 (24%) – CR, 17 (19%) - PR or VGPR. The majority of patients - 56 (63%) had III st. (Durie-Salmon). Kidney damage was presented in 33 pts (37%). The majority of patients had severe lung damage: CT 2 st. - 26 pts (30%), III st. - 35 (39%), IV st.-17 (19%). Patients received standard therapy for COVID19: etiotropic (antiviral, viral neutralizing MAB, convalescent plasma, immunoglobulin), pathogenetic (GCS, interleukin inhibitors, anticoagulants), therapy for secondary infectious complications. Results: IL inhibitor therapy was given 76 patients (85%), 35 (39%) required repeated administration of IL inhibitors. 58 pts (65%) received GCS therapy in various doses. Anticoagulant therapy was conducted in all patients, 51 pts (57%) received LMWH, 37 (42%) received continuous infusion of heparin, 1 patient received NOAC. The frequency of hemorrhagic complications on LMWH and heparin therapy was comparable (5.9% and 5.5%), mortality and the frequency of TEC in patients on heparin therapy were higher (49% and 13% versus 14% and 2% in patients on LMWH therapy, p<0.001 and p=0.034, respectively). It can be explained by the initial severity of patient’s condition, which required heparin therapy (30 pts - 81% had an initially high degree of lung damage - CT 3-4 st.) Secondary infectious complications were reported in 80% of patients: bacterial pneumonia in 71 pts (80%), sepsis in 24 (27%). Infectious endocarditis (2 pts), meningitis (2 pts), colitis (9 pts), colon gangrene complicated by peritonitis (1 patient) were less common. Fungal infections were verified in 19 pts (21%): 6 (7%) – mucosal candidiasis, 13 (14%) – invasive aspergillosis. Infection caused by herpes viruses was detected in 5 patients (6%). There was no significant connection between severity of COVID19, frequency of secondary infections and mortality and level of normal immunoglobulins. The median duration of hospitalization was 19 days versus 9 among patients without MM. 25 patients (28%) were hospitalized in the ICU. The overall mortality was 27% (24 pts), among this patients 71% (17 pts) had active or R/R myeloma and stage III of the disease. The mortality in the ICU was 88% (22 pts). The most frequent causes of fatality were secondary infectious complications in 92% (22 pts), progression of MM in 8% (2 pts). 27 patients (30%) required chemotherapy during COVID-19. Summary/Conclusion: Patient with R/R MM have the highest risk of mortality from COVID19. For patients with multiple myeloma the same COVID19 therapeutic options are effective as for non-immunodeficient patients. Patients with MM and COVID19 also have a high risk of secondary infectious complications.